Nature reviews. Nephrology · 2010
Renal allograft failure in a hyperparathyroid patient following initiation of a calcimimetic.
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Seikrit Claudia, Mühlfeld Anja, Groene Hermann-Josef, Floege Jürgen
Аннотация
BACKGROUND: A 47-year-old man with a 6-year history of chronic dialysis for end-stage renal disease of unknown etiology presented for renal transplantation. While on dialysis, he had developed secondary hyperparathyroidism, which persisted after transplantation despite treatment with cinacalcet.
INVESTIGATIONS: Physical examination, serum and urine analysis, ultrasound of the renal transplant, renal biopsy, bone scintigraphy.
DIAGNOSIS: Severe persistent hyperparathyroidism associated with mild hypercalcemia following renal transplantation. Initiation of a calcimimetic followed by fulminant graft failure. Extensive tubular calcinosis.
MANAGEMENT: Renal transplantation (with immunosuppressant medications: basiliximab, tacrolimus, mycophenolate mofetil, prednisolone), cinacalcet (halted on day 26 after transplantation), angiotensinconverting-enzyme inhibitor, angiotensin-receptor blocker, hydrochlorothiazide, emergency dialysis, subtotal parathyroidectomy.
INVESTIGATIONS: Physical examination, serum and urine analysis, ultrasound of the renal transplant, renal biopsy, bone scintigraphy.
DIAGNOSIS: Severe persistent hyperparathyroidism associated with mild hypercalcemia following renal transplantation. Initiation of a calcimimetic followed by fulminant graft failure. Extensive tubular calcinosis.
MANAGEMENT: Renal transplantation (with immunosuppressant medications: basiliximab, tacrolimus, mycophenolate mofetil, prednisolone), cinacalcet (halted on day 26 after transplantation), angiotensinconverting-enzyme inhibitor, angiotensin-receptor blocker, hydrochlorothiazide, emergency dialysis, subtotal parathyroidectomy.